Hyponatremia in pregnancy has unique multifaceted pathogenesis ⭐✨ ✨⚡

Here is a short 🧵 exploring this intriguing concept

@rabihmgeha @DxRxEdu @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @Sharminzi @rav7ks @RosenelliEM @SatyaPatelMD #MedTwitter #Nephpearls
1.) Reset Osmostat

- Common in first 2 months of pregnancy

- Due to altered osmolality set point at which ADH is released

- Usually asymptomatic with 4-5 mEQ drop in Na levels.

- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.

#MedTwitter
2.) Preeclampsia and SIADH

Proteinuria>> Intravascular volume depletion (akin to Cirrhosis, HF)>> nonosmotic stimulus to release ADH

Abnormal placenta>excess release of Oxytocin

Pregnant patients receive Oxytocin and IV fluids for multiple other reasons as well

#MedTwitter
3. Placenta releases Vasopressinase (causes Diabetes insipidus like state normally)

Abnormal placenta in preeclampsia can't release Vasopressinase> high ADH

Preeclampsia mediated abnormal angiogenesis leading to placental dysfunction and iatrogenic aspects> low Na

#MedTwitter
4. Hyponatremia in pregnancy has relevance for fetus as well.

Fetal Na levels equilibrate rapidly with mother's>> low fetal Na can cause seizures, jaundice, and tachypnea

Reflex suppression of ADH release in the fetus can lead to polyhydramnios

Thanks for reading

#MedTwitter

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More from @KirtanPatolia

Jan 17
Differential dx of deranged PT/INR/aPTT: More than what meets the eye✨

Based on what I have learned from my colleagues

Follow this 🧵

@rabihmgeha @DxRxEdu @DrCindyCooper @AaronGoodman33 @CPSolvers @sargsyanz @AnnKumfer @ASanchez_PS @MatthewHoMD @nihardesai7 #hematology
1.) Isolated Elevation of PT/INR

- Deficiency of or inhibitors against Factors lII, VII
- Early Vitamin K deficiency
- Warfarin (PT/INR>aPTT)

#hematology
2.) Isolated elevation of aPTT

- Deficiency of or inhibitors against Factors XII (asymptomatic), XI, IX, VIII.

- Heparin (aPTT>PT/INR)
- vWD type 2N & Acq vWD

- Antiphospholipid antibodies (further evaluation will dRVVT and phospholipid-based mixing studies)

#hematology
Read 9 tweets
Nov 12, 2022
A cryptic and intriguing connection exists between Methotrexate and Ticagrelor. It's sparkling ✨✨

Here is a short and sweet 🧵

@rabihmgeha @DxRxEdu @rav7ks @tony_breu @Sharminzi @jackpenner @DrCindyCooper @sargsyanz @SatyaPatelMD @ASanchez_PS @AaronGoodman33 #MedTwitter
Methorxate's and Ticagrelor's paths cross each other at the intersection named ADENOSINE

Let's dissect Adenosine receptors

> A1R and A3R (Gi->⬇️cAMP): ⬇️AV node conduction, Bronchoconstricition, ⬆️proinflammatory cytokines from leukocytes

#MedTwitter
A2A and A2B receptors (Gs- ⬆️cAMP > PKA pathway)

- Bronchodilation
- Coronary vasodilation
- ⬇️ proinflammatory cytokines from leukocytes

#MedTwitter
Read 6 tweets
May 27, 2022
The spectrum of Marfan syndrome and related connective tissue disorders is intriguing and mind-bending 💫✨

Here is a🧵exploring it

@CPSolvers @rabihmgeha @DxRxEdu @Sharminzi @AnnKumfer @rav7ks @sargsyanz @DrCindyCooper @jackpenner @MatthewHoMD @ASanchez_PS

#MedTwitter
#2 Skeletal manifestations

-Tall stature
-Long slender arms & legs
-Arachnodactyly
-Pectus excavatum
- Pectus carinatum
-Joint hypermobility
-Pes planus
-Camptodactyly (bent fingers)
-Kyphoscoliosis
-Micrognathia & Retrognathia
-Dolichocephaly
-Malar hypoplasia

#MedTwitter
#3 Cardiovascular

-Mitral valve prolapse (can lead to CHF & arrhythmias)
-Aortic aneurysms
-Aortic root dilation
-Aortic dissection
-Aortic regurgitation
-Pulmonary artery dilation (often asymptomatic)

#MedTwitter #CardioTwitter @Gurleen_Kaur96 @KannuBansalMD @this_is_svenka
Read 19 tweets
May 7, 2022
The journey to the diagnosis of Sweet syndrome and its differentials is too sweet 🍬🍩🍫

Let's explore the sweetness.

@rabihmgeha @DxRxEdu @Sharminzi @DrCindyCooper @jackpenner @sargsyanz @rav7ks @RebeccaEBerger @RosenelliEM @CPSolvers @MithuRheum #MedTwitter #rheumatology
#1 Malignancies & Sweet syndrome

- AML (common)
- MDS (common)
- CML
- MM
- Hodgkin's lymphoma
- NHL
- Mycoses fungoides
- Cutaneous T-cell lymphoma
- Hairy cell leukemia
- Solid tumors

#oncology #hematology #MedTwitter
#2 Autoimmune disorders & Sweet syndrome

- IBD (common)
- Behcet (common)
- SLE (common)
- RA (common)
- Relapsing polychondritis
- Sarcoidosis
- Sjogren's
- Familial Mediterranean fever
- Undifferentiated connective tissue disease
- Erythema nodosum

#rheumatology #MedTwitter
Read 8 tweets
Apr 13, 2022
Differential diagnoses of ⛈️Thunderclap headache⚡ are indeed thunderous.

Here is a brief 🧵.

@AaronLBerkowitz @caseyalbin @rabihmgeha @DxRxEdu @sargsyanz @AnnKumfer @rav7ks @gabifpucci @jackpenner @RosenelliEM @Sharminzi @CPSolvers

#MedTwitter #NeuroTwitter #Neurology
#1 Subarachnoid hemorrhage

Aneurysmal SAH
Cortical SAH (due to RCVS)

- Seizures
- Meningismus
- Altered mental status
- RBC & Xanthochromia in CSF

Look out for possible
sequelae: Rebleeding, vasospasm & ischemia, hydrocephalus

#MedTwitter #Neurology

nejm.org/doi/10.1056/NE…
#2 RCVS

-Multifocal multivessel vasoconstriction (string of beads)
-Recurrent episodes (triggers- bathing, Valsalva, bending, urinating, strong emotions)

Risk factors: Postpartum state, SSRIs, Calcineurin inhibitors, vasoactive drugs, sympathetic overactive states

#MedTwitter
Read 11 tweets
Dec 20, 2021
Differential diagnosis of RA-like arthritis based on the pattern of joint involvement is fascinating

Here is a 🧵 exploring this journey

#medtwitter #RheumTwitter @CPSolvers @rabihmgeha @DrCindyCooper @DxRxEdu @Sharminzi @sargsyanz @rav7ks @RosenelliEM @AnnKumfer @jackpenner
Various patterns of hand joint involvement

- PIP +DIP +1st CMC = OA
- MCP +PIP +Wrist = RA
- 2nd & 3rd MCP = Hemochromatosis
- Wrist +2nd MCP + 2nd PIP + all DIP= PsA
- Dactylitis/Sausage digits = PsA, Sickle cell anemia, Polyarticular gout, Sarcoidosis

#medtwitter @MithuRheum
Infections causing RA-like pattern

- Parvovirus B19
- HTLV-1
- Rubella
- HBV, VZV, Mumps (Large joints more common)
- HIV
- Arboviruses: Chikungunya, Dengue
- Poncet's disease/ Tuberculous Rheumatism

#medtwitter
Read 9 tweets

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